chapter 13 clinical

1. Overview of Personality Disorders

• Definition: Personality disorders involve long-standing patterns of thoughts and behaviors that deviate from cultural norms, causing distress and impaired functioning.

• Types: Classified into three clusters based on shared characteristics.

2. Cluster A: Odd Personality Disorders

• Paranoid Personality Disorder: Characterized by pervasive distrust and suspicion of others, leading to social isolation.

  • Traits: Fear of harm, excessive trust in own beliefs, and reading hidden meanings into benign remarks.

  • Treatment: Limited effectiveness of therapy; some benefit from CBT.

• Schizoid Personality Disorder: Characterized by a preference for solitude and lack of emotional expression.

  • Traits: Indifference to social relationships, limited emotional response, and preference for isolated jobs.

  • Treatment: Limited progress in therapy; CBT can help improve social interactions.

• Schizotypal Personality Disorder: Features unusual thoughts, eccentric behavior, and discomfort in social relationships.

  • Traits: Odd speech patterns, magical thinking, and social anxiety.

  • Treatment: Therapy focuses on improving social skills and cognitive distortions. Medications may help with symptoms.

3. Cluster B: Dramatic Personality Disorders

• Antisocial Personality Disorder: Marked by patterns of manipulation and violation of others' rights; often associated with criminal behavior.

  • Traits: Lack of remorse, impulsivity, deceitfulness, and disregard for safety.

  • Treatment: Difficult due to lack of motivation for change; however, CBT may help individuals recognize moral issues.

• Borderline Personality Disorder (BPD): Characterized by emotional instability, impulsive behaviors, and turbulent relationships.

  • Traits: Fear of abandonment, identity disturbances, and self-harming behaviors.

  • Treatment: Dialectical Behavior Therapy (DBT) is effective in reducing self-harm and improving emotional regulation.

• Histrionic Personality Disorder: Excessive emotionality and attention-seeking behavior.

  • Traits: Constantly seeking approval, emotional outbursts, and dramatized expressions.

  • Treatment: CBT may help develop coping strategies and increase self-reliance.

• Narcissistic Personality Disorder: Involves a pattern of grandiosity, need for admiration, and lack of empathy.

  • Traits: Belief in superiority, entitlement, and sensitivity to criticism.

  • Treatment: Difficult due to the tendency to dismiss weaknesses; psychodynamic therapy may help patients confront underlying insecurities.

4. Cluster C: Anxious Personality Disorders

• Avoidant Personality Disorder: Characterized by social inhibition and feelings of inadequacy.

  • Traits: Sensitivity to negative evaluation, fear of rejection, and chronic feelings of inferiority.

  • Treatment: CBT aimed at improving social skills and addressing fears of criticism; may benefit from exposure therapy.

• Dependent Personality Disorder: Involves excessive need to be taken care of, leading to submissiveness and clinging behaviors.

  • Traits: Difficulty making decisions without advice, fear of separation, and reliance on others for emotional support.

  • Treatment: CBT can help build independence and challenge feelings of helplessness.

• Obsessive-Compulsive Personality Disorder (OCPD): Characterized by a preoccupation with orderliness, perfectionism, and control.

  • Traits: Rigidity, stubbornness, and reluctance to delegate tasks.

  • Treatment: Psychodynamic therapy and CBT can help individuals recognize and adjust their inflexibility and obsessive traits.

5. Emerging Perspectives on Personality Disorders

• Diagnostic Considerations: Diagnosis should not be made until after age 18, as traits can develop and change during adolescence.

• Current Research: Emphasizes the need for a dimensional approach to personality traits and their impact on functioning. The DSM-5 includes trait-specified personality disorders for individuals exhibiting significant impairment due to problematic traits.

  1. Trait Categories:

  2. Negative Affectivity: Emotional instability and anxiety.

  3. Detachment: Social withdrawal and anhedonia.

  4. Antagonism: Hostility and deceitfulness.

  5. Disinhibition: Impulsivity and irresponsibility.

  6. Psychoticism: Unusual beliefs and eccentric behaviors.

6. Conclusion

• Understanding personality disorders is crucial for more effective treatment approaches.

• Therapists need to tailor interventions to the individual’s specific traits and behaviors for optimal outcomes.